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CUSTOM CONTENT • April 8, 2019

HEALTHCARE ROUNDTABLEAn Informative Q&A with OC’s Top Healthcare Professionals

Barry Arbuckle, Ph.D.President and Chief Executive Officer

MemorialCare

Robert T. BraithwaitePresident and CEO

Hoag Memorial Hospital Presbyterian

Kali P. Chaudhuri, MDChairmanKPC Group

Ray ChicoinePresident

Monarch HealthCare

Meghan NewkirkGeneral Manager, Southern California

UnitedHealthcare

Annette M. WalkerPresident

City of Hope Orange County

Erik G. WexlerChief Executive

Providence St. Joseph Health,Southern California

Gene RapisardiMarket President, Southern

California and NevadaCigna

Mark E. CostaSenior Vice PresidentKaiser Permanente

Richard J. GannottaCEO

UCI Health System

Ronald P Jordan, R.Ph. FAPhADean

Chapman University School of Pharmacy

Jennifer MitznerCEO

Hoag Orthopedic Institute

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Chapman University’s School of Pharmacy Chapman University’s School of Pharmacy (CUSP) is Orange County’s first school of pharmacy. Housed at Chapman’sRinker Health Science Campus in Irvine, the first Doctor of Pharmacy class entered in September 2015. CUSP empowersstudents with broad and deep scientific foundations on future therapeutics and flawless personalized patient care, wherepharmacy practice, industry, bio-medical/clinical sciences and global health system informatics intersect. The schooldelivers a three-year “accelerated” Pharm.D. degree, an MS in Pharmaceutical Sciences and a Ph.D. in PharmaceuticalSciences. The high-tech Rinker teaching and research labs provide a unique flipped classroom andragogy and world-classdiscovery experiences for every student.

CignaCigna (NYSE: CI) is a global health service company that helps people improve their health, well-being and peace of mind.The company traces its roots back more than 200 years, but it became the company it is today in 1982 with the merger ofINA Corporation and Connecticut General Corporation. In December 2018, Cigna completed its combination with ExpressScripts to create one of the world’s largest health service companies. The company maintains sales capability in 30countries and jurisdictions, and has more than 160 million customer relationships throughout the world. With more than74,000 employees, it serves customers just about everywhere. Cigna delivers choice, predictability, affordability and qualitycare through integrated capabilities and connected, personalized solutions that advance whole person health. Its operatingsubsidiaries offer an integrated suite of health benefits and services, such as medical, dental, behavioral health, pharmacy,vision and supplemental benefits, as well as group life, accident and disability insurance.

City of HopeCity of Hope is an independent biomedical research and treatment center for cancer, diabetes and other life-threateningdiseases. Founded in 1913, City of Hope is a leader in bone marrow transplantation and immunotherapy such as CAR Tcell therapy. City of Hope’s translational research and personalized treatment protocols advance care throughout the world.Human synthetic insulin and numerous breakthrough cancer drugs are based on technology developed at the institution. ANational Cancer Institute-designated comprehensive cancer center and a founding member of the National ComprehensiveCancer Network, City of Hope is ranked one of America’s “Best Hospitals” in cancer by U.S. News & World Report. Its maincampus is located near Los Angeles, with additional locations throughout Southern California. For more information aboutCity of Hope, follow us on Facebook, Twitter, YouTube or Instagram.

Hoag Memorial Hospital Presbyterian Hoag is an approximately $1 billion nonprofit, regional health care delivery network in Orange County, California, that treatsmore than 30,000 inpatients and 450,000 outpatients annually. Hoag consists of two acute-care hospitals – Hoag HospitalNewport Beach, which opened in 1952, and Hoag Hospital Irvine, which opened in 2010 – in addition to eight health centersand 11 urgent care centers. Hoag is a designated Magnet® hospital by the American Nurses Credentialing Center (ANCC).Hoag offers a comprehensive blend of health care services that includes five institutes providing specialized services in thefollowing areas: cancer, heart and vascular, neurosciences, women’s health, and orthopedics through Hoag’s affiliate, HoagOrthopedic Institute, which consists of an orthopedic hospital and two ambulatory surgical centers.

Hoag Orthopedic InstituteHoag Orthopedic Institute (HOI)’s mission is to optimize the musculoskeletal health of individuals and their communities.HOI opened November 2010 and offers highly specialized and experienced board-certified orthopedic physicians whodeliver patient-centered and value-based orthopedic care. HOI consists of a specialty hospital located in Irvine and threeambulatory surgery centers in Newport Beach, Mission Viejo and Orange. HOI has more than 300 physicians on staff,including more than 80 orthopedic specialists. HOI ranks in the 99th percentile for patients’ likelihood to recommend thehospital and 98th percentile for overall hospital rating, according to Press Ganey’s national database of hospitals. HOIfocuses in the treatments of the knee, hip and spine disorders, and takes pride in specialty care related to sports medicine,orthopedic trauma and extremities care. Since 2010, HOI has been named by U.S. News & World Report and Becker’sOrthopedic, Spine & Pain Management Review as one of the top orthopedic hospitals in the nation, and has beenrecognized by the Centers for Medicare & Medicaid Services (CMS) for earning the highest, five-star rating for overallquality of care.

Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leadinghealth care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. Wecurrently serve 11.8 million members in eight states and the District of Columbia. Care for members and patients is focusedon their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caringmedical teams are empowered and supported by industry-leading technology advances and tools for health promotion,disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente isdedicated to care innovations, clinical research, health education and the support of community health. For moreinformation, go to kp.org/share. For information about Kaiser Permanente Irvine Medical Center, visit kp.org/orangecountyand follow us on Twitter @KPOCThrive.

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KPC HealthKPC Health has an integrated approach to serving the people of Orange, San Bernardino and Riverside County. Our acutecare medical centers provide high quality, comprehensive and affordable healthcare for the entire family. For us, healthcareis not just about caring for our patients, but also about investing in the people throughout our communities. We are oneteam with one mission and that mission is for all our patients, and their families to Enjoy Life in Great Health. KPC MedicalCenters collectively include 1200 beds, 1700 active physicians, and nearly 5,000 hospital personnel.

MemorialCareMemorialCare, a nonprofit Southern California integrated delivery system and innovator in evidence-based medicine, hasover 200 care locations in Orange and Los Angeles Counties; 14,000 employees, affiliated physicians and volunteers; tophospitals—Orange Coast Medical Center in Fountain Valley, Saddleback Medical Center in Laguna Hills; Long BeachMedical Center and Miller Children’s & Women’s Hospital Long Beach; award-winning physician groups MemorialCareMedical Group and Greater Newport Physicians; Seaside Health Plan; and Southern California’s largest high-valueambulatory care network with convenient, cost-effective outpatient surgery, imaging, dialysis, urgent care, health and breastcenters. Its many honors include Best U.S. Health Systems, Largest U.S. Children’s Hospitals, Top 50 Hospitals, Top 50Cardiovascular Hospitals, “A” Grades for Quality and Safety, national listings in U.S. News & World Report’s Best U.S.Hospitals, and more. In 2018’s Patient Assessment survey of 40,000 patients statewide, respondents rated MemorialCareMedical Group and Greater Newport Physicians #1 and #2 in Orange County. And MemorialCare’s remarkable hospitalscontinually appear at the top of “Best Hospital” local media surveys. Visit www.memorialcare.org.

Monarch HealthCareMonarch HealthCare, part of OptumCare, is an Independent Practice Association (IPA) caring for patients since 1994.Monarch is a leading health care delivery organization that is helping transform health care through best-in-class qualitycare and an improved experience through a “patient-first” philosophy of healthcare. With more than 2,500 private-practicephysicians and 220,000 Orange County and Long Beach residents, Monarch has been recognized by health plans andbusiness groups for providing high quality care and excellent service. We aspire to be the solution for affordable quality carefor all patients in the communities we serve. For more information about Monarch, please visitwww.monarchhealthcare.com.

Providence St. Joseph HealthPSJH Southern California is a not-for-profit Catholic health network with 13 hospitals, approximately 90 clinics, TrinityCareHospice and its TrinityKids Care pediatric hospice, Providence High School, home health care services, eight wellnesscenters and numerous physician groups in its Southern California Region. Together these ministries, including secularaffiliates and some representing other faiths, generate $7.5 billion in net revenue and have approximately 35,000employees – called caregivers – and nearly 5,200 physicians on staff. PSJH Southern California is part of Providence St.Joseph Health, a health system of 111,000 caregivers serving in 51 hospitals, 829 clinics and a comprehensive range ofservices across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. PSJH strives to increase accessto health care and bring quality, compassionate care to those we serve, with a focus on those most in need.

UCI HealthUCI Health comprises the clinical enterprises of the University of California, Irvine. As Orange County’s only academichealth system and tertiary/quaternary care center, UCI Health plays a unique, unduplicated role in serving our community’shealth and wellness needs. Patients can access UCI Health at physician offices throughout Orange County and at its maincampus, UCI Medical Center in Orange. U.S. News & World Report has listed the 417-bed acute care hospital amongAmerica’s Best Hospitals for 18 consecutive years. UCI Medical Center features specialty ambulatory care clinics, OrangeCounty’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program,combined Level I trauma center and Level II pediatric trauma center. It is the primary teaching hospital for the UCI School ofMedicine. UCI Health serves a region of more than 3 million people in Orange County, western Riverside County andsoutheast Los Angeles County.

UnitedHealthcareUnitedHealthcare is dedicated to helping people live healthier lives and making the health system work better for everyoneby simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trustedrelationships with care providers. In the United States, UnitedHealthcare offers the full spectrum of health benefit programsfor individuals, employers, and Medicare and Medicaid beneficiaries, and contracts directly with more than 1.2 millionphysicians and care professionals, and 6,500 hospitals and other care facilities nationwide. The company also provideshealth benefits and delivers care to people through owned and operated health care facilities in South America.UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified health care company. Formore information, visit UnitedHealthcare at www.uhc.com or follow @UHC on Twitter.



While we all hope major healthproblems will one day be eliminatedthrough groundbreaking researchand cures, there are simplemeasures that can be taken tomitigate risk in the meantime. Giventhe increased prevalence of life-stylerelated health problems, preventativecare and post-treatment follow-uphave become just as important astreating the actual condition.

Kali P. Chaudhuri, MDChairmanKPC Group

Last year, The Economist reported thatfor the first time in history, health caresurpassed manufacturing and retail –economic engines of the 20th century --to become the largest source of jobs inthe U.S. What will it take to produceexcellent leaders for America’s largestworkforce?

Mark E. Costa, Kaiser Permanente:Successful healthcare leaders mustpossess skills to drive their organizationsinto the future. And organizations likeKaiser Permanente are providing trainingprograms to foster these. EmployeeLeadership: Self-awareness and savvy withinterpersonal communication andrelationship building. A great leader knowshow to build teams of talented employees,act with fairness when dealing with directreports, delegates decision making todevelop employee skills and confidence,coach employees and fosters theirprofessional development and careeropportunities. Drawing on these crucialleadership skills, a great leader creates astrong workplace culture. Secondly,resourcefulness by solving problems withinchallenging operational, regulatory andbudgetary constraints. They get input,allocate resources for maximum impact,and find innovative ways to inspire andempower their teams to deliver superiorpatient care. We additionally place a strongemphasis on composure. We know thatgood leaders navigate within a stressfulenvironment without creating additionalstress by reacting impulsively. They knowhow to manage their own emotions andwork-life balance, and how to support andempower employees to take care ofthemselves. They quickly grasp and devisestrategies to manage change fromseemingly all sides, including technologicaladvancements, new regulatoryrequirements, mergers and integrations,opioid addiction and other complex healthissues. Leaders understand and adapt tochanges themselves, while guiding theworkforce, navigating the human side ofchange management.

Ronald P Jordan, Chapman UniversitySchool of Pharmacy: Health Care leadersneed to develop a patient safety orientationthemselves and be champions of a patientsafety culture within their organizations.There is still far too much preventable deathand harm occurring within the US andGlobal health care economies. New leaderswho plan to ensure zero preventable deathand injury within their span of control will beexcellent. We must overcome our tolerancefor preventable death by enacting knownsolutions and systems that can eliminatethese problems with care. At ChapmanUniversity School of Pharmacy, we areimplementing research and educationprograms intended to have our studentsbecome valued healthcare patient safetyleaders. We intend to lead the nation as apharmacy school developing graduates witha patient safety commitment.

Medicine has made so many advances inthe past few decades. Yet, we have yet tofind cures for big health problems –cancer, heart disease, and diabetes.

What will it take to get us to a cure forthese health concerns?

Annette M. Walker, City of Hope: City ofHope is a unique organization solely focusedon cancer and diabetes. Our mission is“Transforming the future of health. We turnscience into practical benefit. We turn hopeinto reality. We accomplish this throughexquisite care, innovative research, and vitaleducation focused on eliminating cancer anddiabetes." Our 500 physicians and scientificresearchers lead the quest to end theseterrible diseases. They don't just treat cancerand diabetes, but their life’s work is focusedon curing and eliminating these diseases,every day, every hour, and every minute.And we are getting closer. Current examplesof this work are the innovativeimmunotherapy trials for cancer treatments.In addition, City of Hope is on the cusp ofdefeating Type 1 Diabetes, which startedwith our research that led to thedevelopment of synthetic human insulin. Ourcontinued commitment to this kind ofresearch will lead us to cures and, as historyhas shown us many times, it’s places likeCity of Hope where discoveries are madethat change the course of humankind.

Kali P. Chaudhuri, KPC Group: While weall hope major health problems will one daybe eliminated through groundbreakingresearch and cures, there are simplemeasures that can be taken to mitigate riskin the meantime. Given the increasedprevalence of life-style related healthproblems, preventative care and post-treatment follow-up have become just asimportant as treating the actual condition. Inrecognition of this shift, we have initiated asystem-wide health and wellness programwith the goal of promoting a healthierlifestyle amongst our employees and theirfamilies. This program will be expanded toour patients and local communities in thenear future.

According to The California Departmentof Finance, Demographic Research Unit,the number of seniors aged 85 andgreater in Orange County is expected toincrease by 487 percent from 2010 to2060. What impact does this incredibleupturn of super-seniors have on OrangeCounty health care/ What have you doneto improve care for seniors?

Annette M. Walker, City of Hope: While weapplaud those who have achieved super-senior status, it is true this demographictrend represents new challenges. TheAmerican health care system hastraditionally been better at focusing on acuteillness and isn’t as adept at treating thechronic disease and disability that typicallyoccurs among this population. In addition,our systems are designed for the patient tocome to the hospital or clinic. We need tostart doing better at care managementoutside the hospital to reduce cost, improveaccess, and assist people with limitedmobility as much as possible so that theycan lead long and satisfying lives, even withchronic disease such as cancer. And wecan’t forget about mental health. One of themost distinguishing elements of the vision


HEALTHCARE ROUNDTABLE

The American health care systemhas traditionally been better atfocusing on acute illness and isn’t asadept at treating the chronic diseaseand disability that typically occursamong this population. We need tostart doing better at caremanagement outside the hospital toreduce cost, improve access, andassist people with limited mobility asmuch as possible so that they canlead long and satisfying lives.

Annette M. WalkerPresident

City of Hope Orange County



One of the most important emergingtrends is uniting health care andcoverage through providers, healthplans, and pharmacies. Health careorganizations across theseindustries are collaborating in moremeaningful ways in the pursuit ofthe triple aim: better care, betterhealth, and lower costs.

Meghan NewkirkGeneral Manager, Southern

CaliforniaUnitedHealthcare

expressed by our partner Five Point isfocusing on wellness throughout acommunity, particularly for seniors. How weengage our seniors in all aspects of life willsignificantly impact their health.

Ray Chicoine, Monarch HealthCare: Aspeople live longer, we need to explore waysto ensure they stay healthy for just as long.And that’s a challenge because needs canrapidly change and access to care becomesincreasingly vital. Seniors are savvier aboutthe care they want and like, and we need toinnovate in ways to deliver that care when,where, and how they want it. One exampleof what we’re doing: We are working withour physicians at the OptumCare HealthCare Center in Leisure World Seal Beach tobecome long-term partners with the LeisureWorld community to transform the centerinto a state-of-the-art model of health andwellness. This means moving beyondwhat’s already a state-of-the-art clinic towork alongside Leisure World leaders tospread health and wellness across thecommunity with new programs andactivities, all designed to engage membersin their health outside of traditional visits tothe doctor, which will help residents of thisvibrant community lead longer, healthierlives.

Robert T. Braithwaite, Hoag MemorialHospital Presbyterian: High-quality healthcare is an important component of asuccessful community, and Hoag is fullyengaged with the aging population to supportthe health and wellness of our seniorcommunity. We encourage the community tobe proactive and empowered about theirhealth, which is why we offer annual Flu ShotClinics, Health Fairs and CommunityEducation Classes on topics such asMedicare, as well as memory screeningsthrough the Pickup Family NeurosciencesInstitute’s Orange County Vital Brain AgingProgram to help individuals maintain ahealthy brain for life. With a dedication tokeeping seniors healthy and active, theHuntington Beach Senior Center in CentralPark in alliance with Hoag was built in partwith a $3.775 million gift from the HoagCommunity Benefit Program. The Centeroffers Hoag Health & Wellness programmingfree of charge, including health screeningsand presentations by Hoag and HoagMedical Group physicians and experts.

Richard J. Gannotta, UCI Health: UCIHealth is a leader in improving care forOrange County’s seniors. Our recentlylaunched a clinical trial into the use of stemcells to treat and reduce frailty among olderadults and the ongoing 90+ Study into super-agers reflect UCI’s unique role in advancingknowledge that improves care for a growingand often vulnerable and population. Weprovide comprehensive clinical care in a waynot often seen in this population through theUCI Health Senior Health Center, one of thecountry’s first certified Patient CenteredMedical Homes for coordinated geriatricwellness. Our staff and faculty providepreventive care and higher levels of diseasemanagement for chronic conditions such asdiabetes, heart failure and dementia with thegoal to empower patients to manage theirown health.

What are the current trends impactinghealth care? What major trends do youexpect in the next 3-5 years? How will thelandscape be different?

Meghan Newkirk, UnitedHealthcare: Oneof the most important emerging trends isuniting health care and coverage throughproviders, health plans, and pharmacies.Health care organizations across theseindustries are collaborating in moremeaningful ways in the pursuit of the tripleaim: better care, better health, and lowercosts. Through the growing adoption ofvalue-based care models that promote valueover volume, we are developing a healthcare system that is more personalized,simplified and convenient. That's becausevalue-based models focus on quality andusing incentives to reward for better healthand lower costs, driving importantimprovements in how health plans and careproviders work together to support people’scare. Technology is also reshaping howemployers select and offer health benefits toemployees, including widespread adoption ofdigital resources and wearables that arehelping make well-being programs moreengaging. To that end, UnitedHealthcareannually invests more than $3 billion in data,technology and innovation.

Annette M. Walker, City of Hope: So muchis changing in health care, but if I had to pickone trend that excites us now is thewidespread acceptance of wellness,prevention, and early detection. While it istrue that City of Hope provides ground-breaking treatments for those with cancerand other serious illness, we are alsopartnering with our communities to helpprevent these problems in the first place orat least diagnose them at early stages whenthey are most treatable. We also want toensure that those who have had cancer stayhealthy. That’s why City of Hope OrangeCounty will do more than treat disease –it’sreally about preserving health.

Ray Chicoine, Monarch HealthCare: Twotopics come to mind: worker wellness andphysician burnout. For the first topic, wespend a significant amount of time at work;employers have an opportunity to offersupport and programs to engage their staff inways that help them manage their stress,anxiety, and other health needs. Employerswant to know they have an engaged,focused staff. We are exploring how weenhance our offerings to create easieraccess to care. We recognize it’s a keyfactor in keeping people healthy and canmake a difference when it comes topreventing the progression of many diseaseconditions. As for the second, we’re workingwith our affiliated physicians with OptumCareMedical Group to understand physicianburnout and ways to minimize it throughinnovative team-based approaches to patientcare.

Richard J. Gannotta, UCI Health: Weexpect the increase in focus on improvingpatient safety to continue. It’s estimated thatmore than 250,000 people die in U.S.hospitals each year from preventable harm,making it the nation’s third-leading cause of





death. California Department of Public Healthdata for healthcare-associated infectionsshows there is still much work to be done toprotect patients. Healthcare providers canand must do better. UCI Health is leveragingits unduplicated academic and clinicalexpertise to meet this challenge. We’ve developed tools to improve earlyidentification of potentially deadly central linebloodstream infections and UCI Healthrecently became the first academic medicalcenter and the second hospital in the world toimplement the 29 evidence-based ActionablePatient Safety Solutions developed by theIrvine-based Patient Safety MovementFoundation. UCI Health’s efforts haveachieved remarkable results, includingreducing the number of healthcare-associated infections among our patients,improving early detection and treatment ofsepsis and reducing patient exposure todrug-resistant organisms, such as MRSA andVRE.

Ronald P Jordan, Chapman UniversitySchool of Pharmacy: Precision medicinebased on genomic knowledge is developingvery rapidly. Advances in Pharmacogenomicsare permitting us to improve clinicaloutcomes by reducing medication-relatedadverse effects and likely therapy failures.Our genomic knowledge of an individualpatient helps us determine optimal therapiesand therapy administration schedules thatcan avoid unintentional overdose or underadministration when multiple drugs are usedthat depend on the same genetic pathway foractions or elimination from the body.Researchers at Chapman University Schoolof Pharmacy have learned that ninetypercent of drug therapies approved between1930 and 2017 are affected bypharmacogenomics. Over the next few years,more and more drug therapy will rely on fullgenetic profiles that patients will be able toobtain in order to avoid harm.

Health insurers and delivery systems areoften seen as adversaries. Can therelationship be redefined? Is it possiblefor them to work together?

Gene Rapisardi, Cigna: Yes, absolutely, therelationship can and must be redefined if weexpect to create a better health care deliverysystem that produces better outcomes for allstakeholders, including employers,individuals, providers and payers. That’sbeen Cigna's mission for years in SouthernCalifornia, starting right here in OrangeCounty, where we launched an alliance withSt. Joseph Hoag Health in 2015. Ourrelationship is based on deep collaborationand integration. Each party – the providerand the payer – brings its unique abilities andassets to the table to best meet the needs ofemployers and individuals. We extended thismodel to San Diego with Scripps Health andto Los Angeles with HealthCare Partners.The result has been robust solutions thatenable employers to offer benefit plans thatprovide affordable in-network accessthroughout the region, with greater flexibilityfor employees to obtain quality care that’sconvenient to their homes or offices.

Ray Chicoine, Monarch HealthCare: Allstakeholders in the current healthcare

system recognize that reducing the cost ofhealthcare is a top priority for our country.Achieving meaningful change here willinvolve all stakeholders working together.One way to do this is by creating andsupporting physician-led systems of carethat are focused on prevention and providinggreat access to high-quality care. By aligningall partners to this system as a commongoal, from insurance carriers to physiciansand hospitals, we can deliver high-performing services and integrated networksto the patient.

Mark E. Costa, Kaiser Permanente:Fragmentation of our Health DeliverySystems is one major factor leading topoorer health outcomes and higher costswhen comparing the United States to otherdeveloped countries. The lack of alignmentof financial and quality performance goalsbetween Health Plans and Health Providersis one contributing factor to ourfragmentation. Improved alignment of goalsand reduced fragmentation is beingaddressed through new relationshipsbetween Health Plans, physicians andhospitals. Accountable Care Organizations(ACOs) and Integrated Health Systems,such as Kaiser Permanente, are focused onmaking the health of those served the toppriority. Good health and coordinated healthcare also leads to lower costs. Alignmentbetween health plans and health providershas moved beyond a focus solely on treatingthose who are sick and is now placinggreater focus on wellness and prevention.Finally, by working together, such alignedentities can use available data to betterunderstand the personalized needs of thoseserved. This move to personalized care andsupport will again improve both the qualityand cost of services provided.

With Millennials changing jobs so often,why should employers invest inemployee health and wellness?

Annette M. Walker, City of Hope: One ofthe major reasons Millennials job-hop isbecause they do not feel that their companyis investing in their personal andprofessional growth and well-being. That’swhy it’s essential for today’s employers towork with experienced health care providersand develop effective wellness programsthat resonate with their intended participants.Millennials are all about authenticity, sogetting health care experts behind yourwellness program is important. I thinkMillennials also have a little more insightthan my generation did as to how theircurrent lifestyle choices will have an impacton their long-term health. For example, thereis a correlation between obesity inadolescence and young adulthood withearlier onset of cancer. Wellness programsare instrumental in preserving long termhealth benefits. The key is access to thesetypes of initiatives is ensuring easy access,an element of fun, and of course, an on-demand digital component. And, asMillennials start to have families, don't forgetwellness and education programs for theirspouses and children. These tactics will notjust retain, but also attract people to theworkplace.



Fragmentation of our Health DeliverySystems is one major factor leadingto poorer health outcomes andhigher costs when comparing theUnited States to other developedcountries. Alignment between healthplans and health providers hasmoved beyond a focus solely ontreating those who are sick and isnow placing greater focus onwellness and prevention.

Mark E. CostaSenior Vice President

Kaiser Permanente



Are wellness programs worthwhileinvestments for employers?

Gene Rapisardi, Cigna: Yes, they’reabsolutely worthwhile if employers really doview them as investments and not simply asan expense. An expense is just money outthe door, while an investment is spendingthat is expected to provide a payback overtime. In the case of wellness programs, thepayback is lower absenteeism, betterproductivity, and improved health care costs.Cigna's experience is that when ouremployer clients take the time to assess andunderstand the health profile of theirworkforce, then tailor their wellness programsto meet their employees’ specific needs,implement meaningful incentives toencourage participation, and then promotethe program, there is greater employeeengagement and better payback. The resultsdepend entirely on how well the program isdesigned, implemented and communicated,but we see time and again that wellnessprograms provide great value for employersand employees alike.

What does the future look like for theviability of small or independent hospitalsystems?

Kali P. Chaudhuri, KPC Group: InAmerican’s increasingly competitivehealthcare marketplace, the viability of smallor independent hospital systems depends ontheir ability to grow and integrate. Anintegrated model leveraging systemresources for hospitals, physicians, andancillary services is the key to sustainability.Hospital systems are finding themselves inone of two places: acquiring or beingacquired. A fully integrated system means areduction in waste, inefficiencies, andfragmented IT infrastructure.

How are hospitals adjusting to recentlypassed SB 1152 requirements regardingconditions for the release of homelesspatients?

Erik G. Wexler, Providence St. JosephHealth: As a mission-driven organizationliving its values and its vision of “health for abetter world,” Providence St. Joseph Healthand its 13 Southern California hospitals havelong been focused on caring for our mostvulnerable community members. At St. JudeMedical Center, for example, our communitycare navigators help connect homelesspatients to services. We had a head start inmeeting the requirements of SB 1152. Acrossthe county, we always have provided ourhomeless patients the items required by thislegislation. What we have done since the lawtook affect is formalize the process. Work onmeeting the requirements of SB1152 beganwith extensive education to all physiciansand employees on new changes including: Aprotocol regarding care for the homeless,built into the electronic health record, A newtracking system in the records to helppromote continuity of care and Provision ofmedication, clothing, transportation and othernecessities

Kali P. Chaudhuri, KPC Group: Hospitalsare being put in a tough position to address aproblem they did not create. SB 1152 was no

doubt well intentioned by its authors, but itputs a strain on limited hospital resources. Inorder to comply with the new law, we havefocused on working with community partnersto ensure homeless patients get the holisticcare they need for a more stable andmeaningful recovery upon discharge.Connecting our most vulnerable patientswith a support network is critical to theirlong-term success.

What role does patient experience play asit pertains to the delivery of healthcareservices?

Meghan Newkirk, UnitedHealthcare:Providing a personalized, convenient, andsimplified care experience is an essentialfocus in the delivery of health care services.UnitedHealthcare recently launched theSignatureValue Harmony Network, whichunites care and coverage with a focus on thepatient-physician relationship. Withconvenient access to a broad selection ofphysicians located across four counties inSouthern California, patients can create apersonalized relationship with their careprovider – receiving quality care andcoverage that is right for them, at the timethey need it. Harmony delivers a coordinatedcare experience focused on the patient firstwith real-time access to care through adedicated call center and convenient onlinetools, including an easy-to-use mobile app,virtual visits, a dedicated Nurse Line, and24/7 access to myuhc.com. By bringingproviders and hospitals together to improveaccess, quality and affordability,UnitedHealthcare is proud to provideintegrated, cost-effective, and patient-focused health care in Southern California.

Jennifer Mitzner, Hoag OrthopedicInstitute: Since our founding, HOIrecognized that patients have a choice intheir health care, and we built a model tocompete on choice – earning our businessone patient at a time with the highest qualityand exceptional outcomes at a competitiveprice. Because orthopedics is all we do,every member of the care team is focuseduniquely and solely on the patient’scondition. Our specialized care protocolsand culture of unparalleled customer serviceis delivered consistently with our promisethat “We get you back to you.” Today’sconsumerization of health care has made thepatient experience even more importantbecause, at the end of the day, health care isabout human-to-human contact and relievingpain and suffering. HOI has been payingattention to the patient experience from dayone and has been to date, the only 5-StarCMS rated hospital in Orange County forpatient experience.

Annette M. Walker, City of Hope: For Cityof Hope, patient experience is at the heart ofour care. We deliver the most sophisticatedscientific therapies, but we are equallyadvanced in the way we providecompassionate service. Because we havedecades of experience working with patientsand family dealing with cancer and otherserious illness, we understand that peoplecan feel extremely stressed when they needcare. That’s why we have programs such as



Today’s consumerization of healthcare has made the patientexperience even more importantbecause, at the end of the day,health care is about human-to-human contact and relieving painand suffering.

Jennifer MitznerCEO

Hoag Orthopedic Institute



our care navigators who are literally patients’guides, connecting them to all the resourcesthey need, coordinating their appointments,helping them understand their options andtreatments, providing emotional support, andsorting out financial issues or travel. We alsounderstand that education is empowering,which is why we stress programs that teachpatients and families how to manage theirhealth and recovery. I think the words of oneof our founder, Samuel H. Golter, ring true forevery health care organization when he said,“There is no profit in curing the body if, in theprocess, we destroy the soul.”

Kali P. Chaudhuri, KPC Group: Mostpatients have no desire to be in a hospital inthe first place and are often frustrated by alack of readily available information. This isproblematic because patient experiences canbe directly tied to patient outcomes, such astheir willingness to make a follow-upappointment or listen to a doctor’s orders. Tohelp address this issue, we have put policiesand systems in place that are aimed toreduce typical frustrations and improveoverall patient experience. For example, wehave implemented an online check-in optionfor the Emergency Department. In addition,we started a patient satisfaction championprogram that puts frontline healthcareproviders in the driver seat when it comes toensuring maximum patient satisfaction.

Robert T. Braithwaite, Hoag MemorialHospital Presbyterian: At Hoag, we arefocused on a culture of “Own It,” meaningeveryone owns the experience our patientshave regardless of their role. It is a phrasethat was developed by our staff, cliniciansand board several years ago to capture ourpatient experience mindset. When you “own”something, you are invested in the outcome,which is critical when we understand how ourpatients’ experiences affect the quality of theircare, safety and well-being. We are allworking together for the sake of our patientsand families. We are partners with ourpatient—the place they go for health andwellness needs, not just when they are sick.We value the loyalty of our patients and striveto deliver on our mission to provide thehighest quality health care services to thecommunities we serve.

Mental health continues to be an issue formany people. What are health careorganizations doing to proactivelyaddress this need and provide therequired resources?

Barry Arbuckle, MemorialCare: Behavioralhealth is traditionally managed separatelyfrom physical health. When a behavioralhealth diagnosis goes unmanaged, patientsface greater risks for developing chronicmedical conditions. This can lead toadditional medical challenges and three tofive times higher healthcare costs. We believethere’s a better way. MemorialCare piloted aBehavioral Health Integration model withinour Orange County primary care centerswhere primary care physicians, licensedclinical social workers and psychiatristconsultants together address behavioralhealth issues, referrals, communications andscheduling of services. Patients identifiedwith behavioral health issues are referred to

additional resources tailored to their specificneeds that better engage individuals andfamilies on their journey to wellness. Patientappreciation for our interest in their completehealth and well-being resulted in expandingthis model throughout MemorialCare. ForMemorialCare, it’s part of caring for thewhole patient and doing all we can to helpthem live their best, healthiest lives.

Erik G. Wexler, Providence St. JosephHealth: Providence St. Joseph Health iswholly committed to advancing care forthose with mental illness. In 2016, wecreated the nonprofit Well Being Trust,seeding it with $130 million. WBT’s goalsinclude reducing the stigma that preventspeople from seeking help, partnering withother organizations to advance care andfunding innovative care models throughgrants. In addition, our Orange Countyoperations provided approximately $45million last year in funding and services forlocal programs. We provide behavioralhealth services in local schools, counselingfor patients in clinics serving low-incomeareas and outreach to seniors and to familymembers who are caregivers. Recently, wepartnered with other health careorganizations in Orange County’s innovativeBe Well OC program. This novel approach tomental health – a model for othercommunities – will offer long- and short-termtreatment for mental illness as well asaddiction recovery and psychiatricstabilization for patients in crisis.

Gene Rapisardi, Cigna: Cigna's longtimeposition is that mental health is just asimportant as physical health, and we arevery strong proponents of the mind/bodyconnection. In fact, we have launched anational campaign that addresses theimportance of talking to your doctor abouthow you’re feeling emotionally as well asphysically. There’s nothing wrong withadmitting that you’re depressed or anxious,but the stigma associated with mental healthis often a barrier to people seeking effectivetreatment. That’s why Cigna works withShatterproof and other organizations to helpstamp out the stigma. One of the mostimportant things Cigna can do is encourageour employer clients to offer integratedmedical, pharmacy, and behavioral healthbenefits. Our studies show that when thesebenefits are integrated, individuals get morepreventive care screenings and are betterengaged in managing their health. It’s allabout seeing the entire person andemphasizing whole person health.

Kali P. Chaudhuri, KPC Group: Ascurrently constituted, Orange County lacksenough designated facilities to treatbehavioral and mental health issues. Whenthe designated facilities are at capacity, anyadditional cases are sent to EmergencyDepartments. This creates a strain onhospital resources and is not the idealenvironment for treatment. However, there isgood news on the horizon – local electedofficials recognize the need to address thisissue and have committed to doing so. Weare currently working with County leadershipto prioritize the development of a CrisisStabilization Unit (CSU) where those



Behavioral health is traditionallymanaged separately from physicalhealth. When a behavioral healthdiagnosis goes unmanaged, patientsface greater risks for developingchronic medical conditions. This canlead to additional medical challengesand three to five times higherhealthcare costs.

Barry Arbuckle, Ph.D.President and Chief Executive

OfficerMemorialCare


APRIL 8, 2019 Local breaking news: www.ocbj.com ORANGE COUNTY BUSINESS JOURNAL B-49



experiencing a mental health crisis can getthe care they need in the appropriateenvironment.

Mark E. Costa, Kaiser Permanente:Mental Health is a growing crisis affectingall parts of our Orange County populations.Increases in mental health issues for ourelderly and youth are of concern. Efforts ofhealth providers and others are alreadyunderway. Promoting the importance ofMental Wellness and reducing the stigma ofMental Illness is of the utmost importanceas we seek to improve the mental health ofour county. Early and effective screening formental health indicators, just as we screenfor indicators of physical health is essentialto prevent a crisis associated with mentalillness. Health Care Systems must help inconnecting individuals with mental healthvulnerabilities to available resources withinour communities in a timely manner. InOrange County, we are fortunate in that amajor Public-Private effort, BE WELLORANGE COUNTY” is underway. TheCounty of Orange, Cal- Optima, Faith-BasedOrganizations, Education, as well as HealthSystems, including Kaiser Permanente areall working to develop an effective “Systemof Care ‘focused on the Mental Health of all.

Robert T. Braithwaite, Hoag MemorialHospital Presbyterian: Hoag offers accessto highly-trained mental health professionalsto people in various stages of their livesemotionally, mentally and financially. Forexample, Hoag launched ASPIRE (AfterSchool Program: Intervention and ResiliencyEducation) in both Newport Beach andIrvine to help families tackle the life-changing challenges of teen anxiety,depression and other mental healthconditions by developing and practicinghealthy behaviors and coping strategies.Hoag’s Maternal Mental Health Program isdedicated to women experiencing mentalhealth conditions before, during and afterpregnancy through in-person visits as wellas a support line. The Mary & Dick AllenDiabetes Center at Hoag provides mentalhealth support by a licensed clinical socialworker with extensive experience inproviding assistance to adults with type 1 ortype 2 diabetes. Additionally, Hoag’s MentalHealth Center provides psychotherapy forthose who are low income and uninsured orunderinsured through Hoag’s Department ofCommunity Health.

Richard J. Gannotta, UCI Health: Likeother health systems in Orange County andacross California, UCI Health is confrontingthe increasing need to provide mental healthservices, particularly in the emergencysetting. The challenge is to continueproviding a high level of emergency andtrauma care while managing the uniqueneeds of those with mental or behavioralhealth challenges. This spring, UCI MedicalCenter is opening an additional eight bedsfor patients who need general emergencycare and a separate area in which toprovide crisis intervention. This area willfeature 12 emergency bays and provideshort-term psychological care for emergencydepartment patients who require mentalhealth evaluation. Those who live withmental and behavioral health conditions and

their caregivers deserve to be supportedwith the best services we can offer.

People are accessing health care in avariety of ways – digital, inpatient,outpatient – how do health organizationsensure that a consistent and high-qualitypatient experience is delivered?

Erik G. Wexler, Providence St. JosephHealth: Consumer-based health care is nolonger the future. It is here. Health caresystems that are not changing the way theydeliver care won’t keep up with the newmarket. We saw this shift coming and havecreated care options that provide appropriatelevels of care in the most convenient spaces.We’re taking a “customer lifetime journey”view to the business, which also is why ourfocus is increasingly beyond the hospital. Werealize health systems can optimize forthose they serve and manage the costsincurred by being best in class at access andquality across various sites of care.Simultaneously, we support patients’navigation of their health. The key is theProvidence St. Joseph Health brand ofquality, safety and compassion standsbehind our care, no matter if it’s provided inthe home, by an app, at a mini-clinic, anoutpatient center or in one of our hospitals.

Robert T. Braithwaite, Hoag MemorialHospital Presbyterian: A hospital is nolonger defined by a physical building, butrather as a system of care that can providequality services in various environments. AtHoag, we continue to find new ways to bringhigh-quality care directly to the communitieswe serve. This includes the ongoing growthof our health centers and urgent carefacilities, and particularly how our nationallyrecognized specialized services in areas likecancer, neurosciences, heart and vascular,and women’s health are providing expertcare in outpatient settings where ourcommunity can easily access it. Wecontinually seek feedback from ourcommunity on what we are doing well andwhere we have opportunities to improve. Weare working to improve lives through not onlyhearing but truly listening to what ourpatients and families tell us matters most tothem in a health care partner.

The opioid crisis continues to makeheadlines as health systems, pharmacychains, Congress and others in thehealthcare industry seek solutions. Howhas your health system’s approach toaddressing this crisis changed? Whatopportunities exist for the future?

Meghan Newkirk, UnitedHealthcare: Eachday, opioids cause more than 130 overdosedeaths in the United States. To address thishealth issue, a comprehensive approach isrequired, including confronting the often-overlooked connection to dental care.UnitedHealthcare has introduced variousoral health strategies to help reduce themisuse of these drugs, including: All first-time opioid prescriptions written bydental health professionals for people age19 and under are now capped at three daysand fewer than 50 morphine milligramequivalents per day, limiting access to



Consumer-based health care is nolonger the future. It is here. Healthcare systems that are not changingthe way they deliver care won’t keepup with the new market

Erik G. WexlerChief Executive

Providence St. Joseph Health,Southern California



unnecessarily large prescriptions. AllUnitedHealthcare dental plan participantswith dependents ages 16 to 22 will receiveinformation about the risks associated withopioids, specifically in connection to wisdomteeth removal. All dental healthprofessionals in UnitedHealthcare’s network– including a dedicated effort for thoseidentified as among the top 10% of highestopioid prescribers – received informationabout this issue. Following the outreach andinformational campaign, prescribing patternsimproved by 17%.

Gene Rapisardi, Cigna: The opioid crisishas been heartbreaking and it has shatteredfamilies throughout California and acrossthe nation. In 2016, Cigna established anambitious goal to reduce prescribed opioiduse among our commercial customers by25% within three years. Through outreach toprescribing clinicians to gain theircommitment to follow CDC prescribingguidelines, sharing best practices amongphysician groups, education, and usingpredictive analytics to identify at-riskindividuals, we were able to achieve thisgoal in just two years. While we have notdropped these approaches, we have alsoestablished another ambitious goal: reduceopioid overdose by 25% by the end of 2021in certain communities with higher-than-average overdose rates. What’s mostimportant is that we acknowledge opioidmisuse as a chronic condition, andrecognize that people who suffer from thisdisease need treatment without stigma orjudgment. Cigna continues to increaseaccess to evidence-based treatments, suchas medication-assisted treatment.

Mark E. Costa, Kaiser Permanente: Theopioid crisis, is truly a crisis and not ahyperbole. Kaiser Permanente hasresponded to this crisis with a multi-prongedapproach. Through education for physicians,we have ensured that they are up to datewith the literature around the dangers ofopioids, risk of addiction/dependence andoverdose. Physicians are provided lists oftheir patients who are on unsafe opioidlevels or unsafe medication combinations.Furthermore, we put an emphasis oneducation of patients through classes andliterature that are given to patients about therisk of opioids. Opioid addiction is a diseaseand not a moral failure. Kaiser Permanentehas opportunities to work with communitiesto educate and prevent opioid addiction andpromote safe handling of medication so theydon't get into our communities.

Richard J. Gannotta, UCI Health: UCIHealth has the expertise and obligation, asthe region’s only academic medical centerand a vital component of the community’strust, to lead a collaboration of communitypartners in developing solutions to theopioid crisis. Through the SafeRx OCcoalition of healthcare providers,pharmacists, physician groups and countyhealth and law enforcement officials, we’reeducating providers who prescribe opioidmedications to ensure sure they have theright information to prescribe the right painmedication. The coalition’s EmergencyDepartment Safer Prescribing Guidelineshave been adopted in hospitals across the

county and our experts continue to educateprescribers about alternatives and safeprescribing practices. This year, UCI Healthbecame one of only 31 health systemsstatewide and the only one in Orangecounty selected to participate in theCalifornia Bridge Program, an acceleratedtraining program for healthcare providers toenhance access to around-the-clocktreatment for substance use disorder.

How is your system leveragingtechnology, old and new, to improve thepatient experience and patient outcomesacross ambulatory and in-patientsettings?

Barry Arbuckle, MemorialCare: Measuringhealthcare quality using metrics that matteris producing remarkable results. Decadesago, MemorialCare began rigorouslydocumenting quality through extensiveoutcomes assessments that identify bestdiagnostic, treatment and preventivemethods for our hospitals, outpatientcenters and physicians. Additionally, ourdata-warehousing and analytics platformabsorbs data from numerous sources soclinicians can quickly and simply sort,refine, call out and drill down on individualpatients. For example, we can quicklyidentify and schedule patients overdue onmammograms, colonoscopies and otherlife-saving screenings, and those behind onfollow-up to better control diabetes, highblood pressure and other chronic diseasesthat prevent strokes, heart attacks andother conditions. Access to billions of datapoints delivers instantaneous response timefor physicians to determine best courses oftreatment. By moving from managing apopulation to an individual patient in a fewclicks, we’re witnessing extraordinaryimprovements in care, patient experiencesand communications—saving lives,reducing hospitalizations and duplicationand improving community health.

Ray Chicoine, Monarch HealthCare: Weare currently evaluating a pilot withRubiconMD, a new web-based platform.The platform allows the primary carephysician (PCP) to submit consult requeststo leading specialists and academicinstitutions. Within 24 hours the PCPreceives a response. We also have aproprietary system PracticeConnect, whichis a web-based office suite for physicians torefer to specialists and other services. Thenewer technology, RubiconMD, improvescare by combining access to world-classexpertise plus prompt referrals throughPractice Connect. The speed of thesesystems improves the patient experience byallowing the physician to respond quicklyand offer prompt electronic referrals toquality care.

Robert T. Braithwaite, Hoag MemorialHospital Presbyterian: Patients wantaccess to health care in a variety ofways. We place an emphasis on innovationto better meet the needs of our patients,connecting them with their physicians asquickly and conveniently as possible. Thisincludes opening new facilities such asHoag Urgent Cares, which offer online



Through the SafeRx OC coalition ofhealthcare providers, pharmacists,physician groups and county healthand law enforcement officials, we’reeducating providers who prescribeopioid medications to ensure surethey have the right information toprescribe the right pain medication.

Richard J. GannottaCEO

UCI Health System

Patients want access to health carein a variety of ways. We place anemphasis on innovation to bettermeet the needs of our patients,connecting them with theirphysicians as quickly andconveniently as possible.

Robert T. BraithwaitePresident and CEO

Hoag Memorial Hospital Presbyterian



check-in and current wait times, as well asdigital services including telehealth. Theconvergence of these ideas provides Hoagthe opportunity to deliver care efficiently.Hoag is known for a focus on technology,having been nationally recognized for acommitment to pioneering innovativemedical and surgical advancements andinvesting in highly skilled clinical teams andfacilities to expand the comprehensiveservices we offer and improve outcomes.Examples of technology that Hoagpioneered in Orange County include daVinci surgical robots, Breast Tomosynthesis(3D Mammography), Surgical Theater virtualreality technology used in neurosurgery andthe ExcelsiusGPS Robotic Navigationplatform for spine surgery.

Richard J. Gannotta, UCI Health: UCIHealth is proud to leverage its connection toa world-class research institution andleading school of medicine to createsolutions that advance the state of care.Physicians in the H.H. Chao ComprehensiveDigestive Disease Center are improvingcolonoscopy outcomes using artificialintelligence developed to help detectprecancerous polyps. More than 100patients have received AI colonoscopiesand our gastroenterologists continue toperfect the system – soon, all UCI Health GIpatients will benefit from this technology.The Center for Artificial Intelligence inDiagnostic Medicine, the creation of two UCIHealth radiologists, designs AI systems thatcan help identify and outwit diseases. Thecenter’s first effort – already being tested atUCI Medical Center – can analyze a CTscan for cerebral hemorrhages in about 20seconds, a task that often takes more thanan hour in busy ER settings. For strokepatients and radiologists, that’s a bigbreakthrough and a meaningfulimprovement in speeding a patient totreatment.

The cost of health care deliverycontinues to be top of mind among boththe consumers of health care as well asmany employers who pay for health carecoverage. How has your organizationimplemented value-based delivery toreduce the cost of care while alsoimproving quality?

Meghan Newkirk, UnitedHealthcare:Managing costs and care can be achievedthrough value-based care, which pays foractual health outcomes rather than thenumber of procedures. An example is“bundled payments” that reimburseproviders under a single, set payment that isdispersed among everyone involved in thatpatient’s care. UnitedHealthcare’s Spine andJoint Solution payment program has helpedreduce hospital readmissions for eligiblepatients by 22% and led to 17% fewercomplications for joint replacementsurgeries. The program saved on average$18,000 per operation and $3,000 in out-of-pocket costs per procedure. Accountablecare organization (ACO) relationshipspromote a holistic and connected view of apatient’s needs through data-sharing andidentifying needed services. ACOs movereimbursements away from the fee-for-service model to the value-based approach,

where doctors receive incentives based onpatient satisfaction and achieving clinicalmeasures. Placing patients at the center ofthe health care experience can improveboth the quality and cost of care.

Jennifer Mitzner, Hoag OrthopedicInstitute: Hoag Orthopedic Institute (HOI)was created in 2010 for a value-basedmarketplace. Our clinical and businessmodel align all our providers of care aroundquality, experience and cost. HOI has ledthe U.S. with a truly value-based carebusiness model as well as innovatingcommercial bundled payments. As a result,HOI has been recognized as California’shighest volume provider of total hip andknee replacements for the past six years aswell as having some of the lowestreadmission, complication and infectionrates in the nation. As a vanguard in value-based care, HOI played a leadership role inspearheading commercial bundledpayments. Since then, we have cared forover 1,000 commercial bundle patients andnearly 3,000 under Medicare’s bundledpayment program.

Barry Arbuckle, MemorialCare: Asignificant portion of healthcare spendinggoes toward routine imaging and surgery.As Southern California’s largest high-valueambulatory care network, our convenient,high-quality free-standing facilities are notlicensed as part of our hospitals, therefore,are less expensive to operate. Proceduresare priced more competitively,approximately one-third of typical hospitalprices, lowering costs for patients with highdeductibles and insurers for procedures thatcan be performed safely in outpatientfacilities. Our vast networks allow us toparticipate in value-based health plans,including Aetna Whole Health PPO andHMO accountable care organizations, Vivitypartnership with Anthem and other healthsystems and our innovative direct employerarrangement with Boeing. About 316,000patients participate in our value-basedproducts with plans to reach 500,000 by2021. We’re reducing total costs of care,surpassing quality and patient satisfactionmetrics and lowering pharmacy expenses.MemorialCare continues to develop ourhigh-value ambulatory care network throughplanned growth, mergers, acquisitions andaffiliations.

Ray Chicoine, Monarch HealthCare:Value-based delivery is the foundation ofthe quadruple aim: improve the health ofpatients, improve the patient experience,reduce the cost of care, and empowerphysicians. One way we integrate this aiminto our daily work is with an internally-developed set of high-end predictivemodeling tools. We want to proactivelyidentify people who could benefit fromadditional support, and these tools helpmake that possible. We can thenunderstand the individual’s needs and, withthe help of their physicians and our clinicalteams, develop ways to meet those needs.As a team, we all come together to deliverhigh-quality care with lower costs and betteroutcomes, and it all centers on theindividual patient.



Value-based delivery is thefoundation of the quadruple aim:improve the health of patients,improve the patient experience,reduce the cost of care, andempower physicians.

Ray ChicoinePresident

Monarch HealthCare



External market issues such as thepolitical upheaval in Washington, D.C.have disrupted the industry in many waysfor the last two years. How have you metthe challenges of policy changes?

Ronald P Jordan, Chapman UniversitySchool of Pharmacy: Our work on patientsafety research at Chapman UniversitySchool of Pharmacy has helped us realizethat drug therapy shortages are a new formof medication error that is causing harm. Aswe look for the root cause of theseshortages, is clear to me and a pharmaco-economics professor engaged in this area foryears, that shortages result from priorgovernment actions which have imbalancedthe competitive market. The currentadministrations focus on drug prices and themiddlemen Prescription Benefit Managers(PBM’s) and Group Purchasing Organizationprofiteering through kickbacks and rebatesmay help right the market. An antitrust safehaven that is not good for patients that theseorganizations enjoy should be eliminated. Weare hopeful the government will get there inits quest for lower drug costs.

The proliferation of value-based healthcare is changing the way physicians andhospitals provide care in Orange County.How are you ensuring the continuation ofvalue-based health care as you expandoperations and include outside partnersin your enterprise?

Jennifer Mitzner, Hoag OrthopedicInstitute: As a specialty hospital, HoagOrthopedic Institute knows who we are andwho we are not. Our culture was driven byentrepreneurial private-practice physicianswho wanted to deliver value-based care ofthe highest quality to patients. That visionand conviction have built a business modelthat has been hardwired to drive greaterunderstanding of our patients’ needs and toscale their experience without compromisingon quality and experience. In the lastseveral years, as we have grown ourbusiness model and footprint in OrangeCounty, we have incorporated our value-based model with new partners andaffiliates. We are currently engaged with ournewest allied partner, ProSport PhysicalTherapy and Performance, to reinvent themodel of orthopedic care, rehabilitation andsports performance, a model that will aim toimprove the overall patient experience,outcomes and save time and money forpatients.

Barry Arbuckle, MemorialCare: Manyhealth systems talk about value. Few deliverit. To truly deliver value health systems mustprovide lower cost, easily accessiblelocations. MemorialCare—the region’slargest high-value ambulatory network ofurgent care, surgery, dialysis and imagingcenters—last year tripled our network ofconvenient, lower-cost imaging centers nearwhere people live and work. MemorialCare’snetwork attracts health system partners forour value-based health plan offerings,including Cedars-Sinai, UC Irvine Health,UCLA Health and other leading healthsystems, health plans and employers. Ouracademic partnerships increase theavailability of highly trained physicians,

nurses and other clinicians. An affiliationbetween Miller Children’s & Women’sHospital and UCLA Mattel Children’sHospital enhances access to highly trainedspecialists and children’s healthcareservices. Patient satisfaction remainsstrong. In 2018’s Patient Assessmentsurvey of 40,000 patients statewide,respondents rated MemorialCare MedicalGroup and Greater Newport Physicians #1and #2 in Orange County. AndMemorialCare’s remarkable hospitalscontinually appear at the top of “BestHospital” local media surveys.

Employers are becoming a moreimportant stakeholder in the health caredelivery system. How does yourorganization engage with corporateentities and what results do those haveon patient care, costs and access?

Meghan Newkirk, UnitedHealthcare:Employers can help curb health care costsby using technology to reshape howbenefits are offered to employees. Enablingaccess to information simplifies the process,creating an affordable and interactiveexperience. By utilizing online resources,such as UnitedHealthcare’s Health PlanManager, employers can analyze data tocreate employee-engagement programs,comparison shop for health care based onquality and cost, and simplify health careterms. These online resources encourageengagement, contributing to improvedhealth outcomes and mitigated expenses.Encouraging employees to lead healthierlifestyles through well-being programs(including wearables) is yielding potentialcost-savings – including financial incentivesfor achieving fitness goals and renewaldiscounts for employers based onaggregate team results. Finally, employerscan maximize the effectiveness of theirhealth care dollars by selecting specialtybenefits, such as vision, dental anddisability coverage as part of an employee'smenu of benefits - creating peace of mindand building a culture of health.

Jennifer Mitzner, Hoag OrthopedicInstitute: Orange County has always beena great vacation destination; however, it isfast becoming a great destination for travelmedicine as well, particularly forcommercial bundled payment patients.Hoag Orthopedic Institute was the first inOrange County to pioneer the developmentof commercial bundle payment models forlocal and national employers. Bundledpayments are simply a fixed cost for anepisode of care such as knee or hipreplacement, with a warranty pledge. Jointreplacements continue to be a major costfor many employers as they are one of themost common surgeries performed in theU.S. Patients who participate withemployer-based direct contractingprograms, including many in OrangeCounty, come to HOI from all over the U.S.Our bundled payment patients and theiremployers report a high degree ofsatisfaction with this program and while thisbusiness is great for HOI, it also serves asa positive economic driver for all of OrangeCounty.



Drug therapy shortages are a newform of medication error that iscausing harm. As we look for theroot cause of these shortages, isclear that shortages result from priorgovernment actions which haveimbalanced the competitive market.

Ronald P JordanDean

Chapman University School ofPharmacy



Barry Arbuckle, MemorialCare: Employersare seeking better value in the care theiremployees receive and health benefits theyoffer. MemorialCare addresses this byoffering more value-based options foremployers than any other health system inour communities. These include direct-to-employer customized contracts in which weaccept responsibility for healthcare costtrend and quality expectations.MemorialCare is The Boeing Company’spreferred partner for California’s first-of-its-kind customized health plan option for manySouthern California Boeing employees. In itsfirst year, this innovative partnership reducedtotal cost-of-care by 4 percent, in part byreducing pharmacy spending by 21.5percent and dramatically reducing inpatienthospital admissions and emergencydepartment visits. And a 20 percentenrollment growth indicates high employeesatisfaction. During the second of the five-year contract, Boeing and MemorialCareagreed to extend our partnership anadditional two years. We also offer solutionsto counter unhealthy lifestyles by engagingmany local employers, schools andcommunity organizations in healthy livingpartnerships.

Erik G. Wexler, Providence St. JosephHealth: Employers know that to attract thebest and brightest they must invest in quality,affordable health care coverage thatstresses wellness but also provides accessto all levels of expert care in one electronichealth care record. Through our employerrelations program, we partner withemployers to develop comprehensiveemployee wellness strategies that focus oneffective illness prevention and lifestylechanges. We provide on-site programs forhigh-risk individuals that reduce hospitalreadmissions and emergency visits, and wemake care accessible via health coachingand telemonitoring. We also bring themedical office to the employer with WellnessCorners that are close to local businesses,and onsite wellness centers that focus onhealthy lifestyle choices. Rising costs haveprompted employers to explore options tobetter control the health care options theyprovide. They are finding that directcontracts between health care providers andemployers helps control costs for qualityhealth care services.

Gene Rapisardi, Cigna: Consulting withemployers is an important part of the workwe do every day. For example, we adviseemployer clients on how to create a cultureof health within their organization and how toimplement a successful wellness program.We also help them determine what type offunding arrangement to choose and evaluatedifferent health benefits plans that will bestmeet their needs and the needs of theiremployees, such as HMO, open access,high-deductible plans, etc. Do they want tooffer a very broad network at a higher cost ordo they prefer a high-performing networkthat’s smaller but offers access to qualitycare at a better price? There are dozens ofdecisions that employers need to make thataffect their health benefits budget as well asthe health, well-being and productivity oftheir employees. It’s our job to help themmake choices that are right for them.

Value-based care is an important issuefor many providers, including in OrangeCounty. How has your organizationadopted value-based care initiatives?What are the benefits of the emergingvalue-based initiatives and how will itaffect healthcare providers, employersand patients in Orange County?

Erik G. Wexler, Providence St. JosephHealth: Value-based health carestandardizes care by creating protocolsthat improve quality while helping to reducerising costs. It aligns with our strategy totransform how health care is delivered.Through innovation, teamwork and thesupport of colleagues across our 51-hospital, seven-state system, ProvidenceSt. Joseph Health has seen someremarkable successes. Notably, sepsis“bundles,” encourage timely recognition ofthe very serious blood infection, quickdiagnostics and immediate treatment asnecessary. The practice saves lives.Similarly, standard protocols for jointreplacement knee surgery create expertisethrough repetition with steps that include,for example, the timeliness of getting apatient walking as soon as possible aftersurgery to hasten recovery, which results inshorter hospital stays.

Outpatient care is still trending upwardsas both a convenience and cost-savingfocus for consumers, employers andhealth plans. How have you addressedthis transition and how has the growthof outpatient care advanced value inhealth care?

Jennifer Mitzner, Hoag OrthopedicInstitute: Hoag Orthopedic Institute wasfounded in 2010 on a model thatanticipated the shift to more outpatientcare. HOI is comprised of a 70-bedinpatient hospital in Irvine as well as threeambulatory surgery centers in NewportBeach, Orange and Mission Viejo. We alsorecently partnered with ProSport PhysicalTherapy and Performance to further ourbusiness model into non-surgical outpatientcare of musculoskeletal conditions,embracing that “getting you back to you”does not always require a surgicalapproach. The outpatient trend willcontinue to grow commensurately as moreand more procedures evolve to outpatientcare status. Our strategic plan calls for thebuilding of more ambulatory surgerycenters throughout Orange County andgreater Southern California, increasingaccess to outpatient orthopedic care inmore communities.

Ray Chicoine, Monarch HealthCare: Wehave a number of clinician-led healthprograms to guide our members andprovide them with valuable resources andservices. Externally we look to our affiliatesand other partners such as Surgical CareAffiliates (SCA), a network of ambulatorysurgery centers. SCA joined Optum in 2017and offers our members access to high-quality and affordable surgical care. Weshare a similar focus on patient outcomeswith SCA and know our members arebenefitting from the highest quality facilitiesand surgeons in our community.


There are dozens of decisions thatemployers need to make that affecttheir health benefits budget as wellas the health, well-being andproductivity of their employees.

Gene RapisardiMarket President, Southern

California and NevadaCigna


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